As a representative drug of glycopeptide antibiotics, vancomycin is a first-line therapeutic agent for infections caused by drug-resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus. According to the existing theories, it is believed that prolonging the administration time via continuous intravenous infusion can improve the clinical efficacy and safety of time-dependent antibiotics. However, the efficacy and safety of vancomycin administered by continuous intravenous infusion, despite as a time-dependent antibiotic, remain at the theoretical level and case study stage. Therefore, in this article, the efficacy and safety of vancomycin administered by continuous intravenous infusion in different populations are reviewed to provide a reference for improving the clinical efficacy and medication safety of vancomycin.

Objective: To investigate the stability of ceftriaxone-tazobactam sodium finished infusion under different temperature and solvent conditions, and provide a reference for improving the quality of ceftriaxone-tazobactam sodium finished infusions prepared in the Pharmacy Intravenous Admixture Services. Methods: 1.0 g of ceftriaxone-tazobactam sodium (750 mg ceftriaxone and 250 mg tazobactam) was sequentially dissolved in 250 mL of 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection. The solutions were then placed at 25 °C and 2-8 °C for 0, 2, 4, 8, 12, and 24 hours, respectively. The changes in pH values and the degradation rates of active ingredients of ceftriaxone-tazobactam sodium finished infusions under different temperature and solvent conditions were observed. Results: At 25 °C, the degradation rates of ceftriaxone in 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection within 24 hours were all lower than 10.00%, while the degradation rates of tazobactam in these four solvents within 12 hours were all lower than 10.00%, and only the degradation rate in 5% glucose and sodium chloride injection was lower than 10.00% when placed for 24 hours. At 2-8 °C, the degradation rates of both ceftriaxone and tazobactam in 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection within 24 hours were lower than 5.00%. Under both 25 °C and 2-8 °C conditions, the pH values of ceftriaxone-tazobactam sodium finished infusions showed minimal fluctuations (ranging from 0.00 to 0.17) within 24 hours. Conclusion: The ceftriaxone-tazobactam sodium finished infusions prepared with four common solvents should not be stored for more than 12 hours at 25 °C or more than 24 hours at 2-8 °C. Under these conditions, the degradation rates and changes in pH values of the ceftriaxone-tazobactam sodium finished infusions are small, which can ensure the safety and efficacy of the drug.

Objective: To analyze the process of antimicrobial therapy and pharmaceutical care for one patient with cervical necrotizing fasciitis (CNF) caused by Streptococcus constellatus, and provide a reference for the treatment of such patients in clinical practice. Methods and Results: The patient presented with sore throat and bloody sputum after consuming fish one week ago, followed by swelling and pain in the left neck, chest tightness, and difficulty in eating. CT examination in another hospital suggested cervical soft tissue infection, and considering the severe condition, the patient was transferred to our hospital. Admission examinations showed persistent fever, significantly abnormal infection indicators such as white blood cell count, neutrophil percentage, and C-reactive protein. CT indicated possible infectious lesions in the larynx and neck, so debridement and drainage surgery was performed, and pus and drainage fluid were collected for microbial culture. Empirical antimicrobial therapy with linezolid plus meropenem was initiated postoperatively. Three days later, Streptococcus constellatus was isolated from the pus and drainage fluid, which was sensitive to linezolid. Considering the possibility of mixed infection, the current antimicrobial therapy regimen was maintained. Another four days later, the patient's infection indicators improved significantly, but large-area rash appeared on the back. Clinical pharmacists ruled out other causes and considered it might be caused by meropenem, so meropenem was discontinued. Another four days later, the patient developed intermittent fever again, and the white blood cell count increased. Sputum culture detected Stenotrophomonas maltophilia, but lung imaging showed no abnormalities. Therefore, it was considered that Stenotrophomonas maltophilia was likely a colonizing bacterium, and the recurrence of the disease was possibly attributed to incomplete treatment of CNF. Clinical pharmacists suggested adding levofloxacin, which was adopted by the doctor. One week later, the patient no longer had fever, and the white blood cell count returned to normal. Conclusion: As a severe infectious disease, CNF is caused by complex pathogens. Even if a single pathogen is detected, the possibility of mixed infection should not be ruled out. The principles of combined and full-course treatment should be adhered to ensure the effect of antimicrobial therapy.

Objective: To analyze the process of antimicrobial therapy and pharmaceutical care for one patient with traffic accident injury complicated by Mycoplasma hominis bloodstream infection, and provide a reference for clinical antimicrobial treatment of patients with Mycoplasma hominis infection. Methods and Results: The patient was admitted to the hospital due to systemic contusion, fracture, and severe abdominal injury caused by a traffic accident. Surgical treatment was immediately performed after admission, and cefoperazone-sulbactam sodium was administered postoperatively. Two days later, the patient's white blood cell count, neutrophil percentage (NEUT%), and C-reactive protein (CRP) levels were all abnormal. Subsequently, fever, abdominal pain, and an increase in procalcitonin level occurred, indicating concurrent infection with a trend of aggravation, so meropenem was used instead. After 2 weeks of treatment, the patient's infectious symptoms improved significantly, and NEUT% and CRP also improved compared with before. However, the next day, the patient developed fever again, and the CRP level increased abnormally. Clinical pharmacists considered the possibility of other secondary infections, so they suggested improving etiological examinations and adding amikacin. Two days later, Mycoplasma hominis was detected in the culture of the tip of the patient's intravenous catheter. After comprehensively evaluating the patient's previous conditions, clinical pharmacists suggested adjusting the antimicrobial treatment regimen to doxycycline + meropenem. Another two days later, Mycoplasma hominis was also detected in the patient's blood culture, and the drug susceptibility test showed that it was sensitive to doxycycline. After 2 weeks of treatment with doxycycline, the patient's infectious symptoms basically disappeared, the infection indicators returned to normal, and the blood culture results also turned negative. Conclusion: As an atypical pathogen, mycoplasma is often ignored in clinical empirical antimicrobial treatment. When the empirical treatment has poor effect, the possible pathogens should be fully considered, and etiological examinations should be improved. After obtaining pathogen information, targeted antimicrobial treatment and pharmaceutical care should be carried out in a timely manner to ensure the effect of antimicrobial treatment for patients.

Objective: To analyze the process of antifungal therapy and pharmaceutical care for one patient with AIDS complicated by Talaromyces marneffei (TM) infection, and provide a reference for the clinical treatment of such patients. Methods and Results: The patient with AIDS was admitted to the hospital due to unexplained sore throat, dry mouth, shortness of breath after activity, and general malaise. Examinations at admission showed significant abnormalities in indicators such as neutrophil percentage (NEUT%), C-reactive protein (CRP), and procalcitonin (PCT), so empirical treatment with compound sulfamethoxazole was given. The next day, the patient developed fever, and lung CT showed scattered inflammation and local consolidation in both lungs, so piperacillin-tazobactam sodium was added. One day later, fungal hyphae were detected in the patient's blood culture, and the result of G test was 242.664 pg/mL. In combination with the umbilicated rashes and acne-like lesions scattered on the face and back, TM infection was highly suspected. Then, amphotericin B colloidal dispersion (ABCD) was immediately given for induction therapy. The next day, the patient's blood culture reported positive for TM, and bone marrow smear also showed phagocytes phagocytizing TM, confirming the diagnosis of TM infection. During ABCD treatment, when the dose was "150 mg, q24h", the patient developed acute kidney injury, so the dose was reduced to "100 mg, q24h". After 2 weeks of ABCD induction therapy, the patient's body temperature returned to normal, and the levels of infection indicators such as NEUT%, CRP, and PCT significantly decreased, so it was switched to voriconazole (0.2 g, q12h) for sequential therapy. Four days later, considering that the patient's condition was relatively stable, he/she was allowed to be discharged. However, one month after discharge, the reexamination of CT scan showed that the pulmonary infection had progressed compared with that at discharge, which was considered possibly related to insufficient ABCD dose during induction therapy or individual differences in voriconazole. Conclusion: ABCD and voriconazole are recommended drugs for the treatment of patients with AIDS complicated by TM infection. Standardized treatment with sufficient course and dose is the guarantee to achieve good curative effect. Due to the large individual differences in voriconazole plasma concentration, clinical plasma concentration monitoring should be carried out as much as possible to achieve individualized adjustment of medication and ensure the treatment effect of patients.

Objective: To analyze the occurrence and treatment process of thrombocytopenia caused by the concomitant use of vancomycin and piperacillin-tazobactam sodium, and provide a reference for the safe clinical use of vancomycin and piperacillin-tazobactam sodium. Methods and Results: The patient was admitted to the hospital due to "unconsciousness with limb convulsions for 2 hours". The examinations at admission showed that the patient had fever, and infection indicators such as white blood cell (WBC) count, neutrophil percentage (NEUT%), and C-reactive protein (CRP) were at high levels, suggesting the presence of infection. Therefore, piperacillin-tazobactam sodium was empirically administered. Subsequently, pathogens such as Klebsiella pneumoniae subsp. pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa were successively detected in various specimens of the patient, so vancomycin was added. However, the patient's fever symptoms and infection indicators did not improve significantly, so the dosage of vancomycin was adjusted from "500 mg, q12h" to "500 mg, q6h". In the following days, the patient's platelet count rapidly decreased from 124×10⁹/L to 7×10⁹/L, so platelet transfusion was immediately given. Meanwhile, after evaluation, the thrombocytopenia was possibly related to vancomycin and piperacillin-tazobactam sodium, so the two drugs were immediately discontinued, and cefoperazone-sulbactam sodium was used for antimicrobial treatment. The next day, the patient's platelet count recovered to 74×10⁹/L. Conclusion: Both piperacillin-tazobactam sodium and vancomycin have the potential risk of inducing thrombocytopenia, and the concomitant use of them may have a superimposed risk. Therefore, it is necessary to strengthen the monitoring of adverse drug reactions for the clinical use of the two drugs to ensure the safety of medication for patients.

Objective: To analyze the clinical characteristics and prognosis of patients with pulmonary cryptococcosis, and provide a reference for the clinical identification, diagnosis, and treatment of pulmonary cryptococcosis. Methods: A total of 20 patients with pulmonary cryptococcosis admitted to Shangrao People's Hospital from July 2022 to December 2023 were selected as the research objects. Information such as age, gender, underlying diseases, clinical manifestations, laboratory and imaging examination results, medication conditions, and prognosis were collected to analyze the clinical characteristics and prognosis of patients with pulmonary cryptococcosis. Results: Among the 20 patients with pulmonary cryptococcosis, the middle-aged and elderly aged ≥40 years old were the main group (16 cases, 80.00%), and most of them had a history of smoking (12 cases, 60.00%) and immunodeficiency (11 cases, 55.00%). The main clinical symptoms of patients with pulmonary cryptococcosis included cough (14 cases, 70.00%), expectoration (9 cases, 45.00%), fever (9 cases, 45.00%), and malaise (7 cases, 35.00%). 7 cases and 11 cases underwent G test and GM test respectively, but the results were all negative. 12 cases underwent serum latex agglutination test, among which 10 cases were positive, with a positive rate of 83.33%. Imaging manifestations of pulmonary cryptococcosis mostly showed nodular/mass type (14 cases, 70.00%), among which single nodular/mass type was more common (10 cases). In terms of affected sites, the lower lobes of the lung (17 cases, 85.00%) and peripheral lung (17 cases, 85.00%) were the main sites. Among the 20 patients with pulmonary cryptococcosis, the vast majority had treatment outcomes of being cured (5 cases, 25.00%) or improved (12 cases, 60.00%). Conclusion: Pulmonary cryptococcosis mostly occurs in middle-aged and elderly people, and its clinical and imaging manifestations have obvious characteristics. Clinicians should pay attention to identification in early diagnosis. In addition, the prognosis of patients with pulmonary cryptococcosis is mostly good under standardized treatment.